Long-Term Prognostic Value of High-Sensitivity Troponin T Added to N-Terminal Pro Brain Natriuretic Peptide Plasma Levels Before Valve Replacement for Severe Aortic Stenosis.

Abstract

Natriuretic peptide plasma levels help to manage patients with severe aortic stenosis (AS). The role of troponin plasma levels in this patient cohort remains speculative. A consortium of 4 university hospital centers in Austria analyzed retrospectively 3,595 patients admitted for valve replacement because of severe AS since 2007. The aim was to compare the additive preprocedural value of high-sensitivity troponin T (hsTnT) to N-terminal pro brain natriuretic peptide (NT-proBNP) plasma levels in predicting postoperative long-term survival in a large cohort undergoing either surgical (57.8%) or transcatheter (42.2%) aortic valve replacement. During a median follow-up of 2.93 (1.91 to 4.92) years, 919 patients (25.6%) died, in them 556 (15.5%) due to cardiovascular causes. Both normal hsTnT (<14 ng/l) and NT-proBNP (within age- and sex-corrected normal range) plasma levels were found in 481 patients (14.3%, group 1). Normal hsTnT but elevated NT-proBNP plasma levels were found in 748 patients (22.3%, group 2). Elevated hsTnT but normal NT-proBNP plasma levels were found in 258 patients (7.7%, group 3). Both elevated hsTnT and elevated NT-proBNP plasma levels were found in 1,869 patients (55.7%, group 4). Using Log Rank tests for comparison there was a highly significant difference in both cardiovascular mortality (p <0.0001) and all-cause mortality (p <0.0001). All-cause mortality rates after 1, 3, and 5 years were 2.1%, 5.4%, 7.7% in group 1; 4.0%, 7.5%, 11.5% in group 2; 5.8%, 8.9%, 14.0% in group 3; and 12.3%, 22.6%, 28.4% in group 4. In conclusion, hsTnT adds additional impact to NT-proBNP as a routinely available biomarker for risk stratification concerning postoperative survival in patients with severe AS admitted for valve replacement. The present study supports the concept to integrate hsTnT plasma levels in the management of severe AS.

• Authors: Fabian Barbieri, Thomas Senoner, Agne Adukauskaite, Stephan Dobner, Johannes Holfeld, Severin Semsroth, Thomas Lambert, David Zweiker, Thomas Theurl, Peter Paul Rainer, Albrecht Schmidt, Gudrun Maria Feuchtner, Clemens Steinwender, Uta Charlotte Hoppe, Florian Hintringer, Axel Bauer, Silvana Müller, Michael Grimm, Bernhard Erich Pfeifer, Wolfgang Dichtl
• Journal: The American journal of cardiology (Am J Cardiol) Vol. 124 Issue 12 Pg. 1932-1939 (12 15 2019) ISSN: 1879-1913 [Electronic] United States
• PMID: 31699359 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers
• Peptide Fragments
• Troponin T
• pro-brain natriuretic peptide (1-76)
• Natriuretic Peptide, Brain

Topics

• Aged
• Aortic Valve Stenosis (blood, diagnostic imaging, mortality, surgery)
• Austria
• Biomarkers (blood)
• Cohort Studies
• Echocardiography, Doppler (methods)
• Female
• Heart Valve Prosthesis
• Heart Valve Prosthesis Implantation (methods, mortality)
• Hospitals, University
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Natriuretic Peptide, Brain (blood)
• Peptide Fragments (blood)
• Preoperative Care (methods)
• Prognosis
• Retrospective Studies
• Risk Assessment
• Sensitivity and Specificity
• Severity of Illness Index
• Survival Rate
• Time Factors
• Treatment Outcome
• Troponin T (blood)